www.mercycareplan.com                                  www.mercymaricopa.org
January 10, 2018
Non-emergent transportation - documentation required for trips 100 miles or more
Effective February 1, 2018, Mercy Care will require further documentation of  all non-emergent transportation greater than 100 miles per total trip via submission of the pick-up/drop-off locations.  In order to prevent a denial, the pick-up/drop-off locations must be submitted with the claim.  Claims submitted without pick-up/drop-off locations will be denied for that information.  Mercy Care will be conducting further review of these claims on a pre-payment basis when the trip ticket is attached. 

AHCCCS currently requires prior authorization for these services.  Rather than require prior authorization, Mercy Care will instead conduct pre-payment reviews.     
Instructions for Submitting Claims Electronically:  Claims submitted electronically will need to have the correct information loaded into the appropriate loops on the 837P files that are sent to us. According to CMS guidelines, pick-up information should be included in Loops 2310E if it is at the claim level or 2420G if it is at the line level. Drop-off information should be included in Loops 2310F for claim level information and 2420H for line level. The requirements for both of these are under the 5010 standards are as follows:
"Required when billing for ambulance or non-emergency transportation services. If the location is in an area where there are no street addresses, enter a description of where the service was rendered. (For example, 'crossroad of State Road 34 and 45.)"
Instructions for Submitting Claims via Paper:  Trip ticket should be included. 

As always, don't hesitate to contact your Mercy Care  or your Mercy Maricopa Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care Plan or Mercy Maricopa website.   

Thanks for all you do!

QB 3182
www.mercycareplan.com                        www.mercymaricopa.org